After health insurance was expanded under the Affordable Care Act (ACA), significantly fewer previously uninsured middle-aged people died of sudden cardiac arrest, according to a study conducted in Oregon and published online today in the Journal of the American Heart Association.

As background information in the study points out, previous research has shown that health insurance leads to improved financial security, greater access to preventive medical services and more positive self-perceptions of health. But it’s been unclear if health insurance also has an effect on major health outcomes, such as the incidence of sudden cardiac arrest (SCA).

SCA occurs when an electrical disturbance in the rhythm of the heartbeat (an arrhythmia) causes the heart to suddenly and unexpectedly stop beating. In about 95 percent of cases, the person dies within minutes, mainly because quick treatment with a defibrillator is not available. SCA is not the same as a heart attack, which occurs when a major artery leading to the heart become blocked. Although both are serious, the heart doesn’t usually stop beating during a heart attack, although a heart attack patient may experience an SCA later, during the recovery period.

SCA is a leading cause of death in the United States, claiming about 350,000 lives each year. That’s about one life every 90 seconds.

Before and after

The current study is based on a comparative analysis of emergency medical services data collected in Multnomah County, Oregon, during a two-year period before the ACA’s insurance expansion mandate went into effect (2011-2012) and a two-year period afterward (2014-2015). The county is home to the city of Portland and has an adult population of about 636,000.

The analysis found that the incidence of sudden cardiac arrest dropped 17 percent among people aged 45 to 64 between 2011-2012 and 2014-2015. The incidence remained unchanged, however, among adults aged 65 and older — a group that has almost universal health coverage under Medicare.

Most of the middle-aged adults in the study gained their insurance through Medicaid. Medicaid coverage grew in the county from 7.0 percent before the ACA to 13.5 percent afterward — a 93 percent increase.

“Cardiac arrest is a devastating and under-recognized cause of premature death for both men and women age 45 and older,” said Dr. Eric Stecker, the study’s lead author and a cardiologist at Oregon Health & Science University, in a released statement. “Health insurance allows people to engage in regular medical care, which is crucial for the prevention of cardiovascular disease and the diagnosis and treatment of conditions that can cause cardiac arrest.”

Limitations and implications

The study comes with several caveats, as its authors point out. Most notably, it is observational, which means it can show only an association, not a direct cause-and-effect, between greater access to health insurance and a lower incidence of cardiac arrest. Also, this research was a pilot study. Larger studies involving more diverse populations are needed to confirm its findings.

Still, the study comes on the heels of a review of past studies that have examined the influence of health insurance on various aspects of health. That analysis, published Monday in the Annals of Internal Medicine, concluded that adults who lack health insurance have “poorer health and shortened lives.”

Specifically, the review found that people without health insurance are between 71 percent and 97 percent more likely to die early than those with health insurance. That means that for every 1 million Americans without health insurance, about 1,300 will die prematurely each year.

CardiologyCardiology is a specialty of internal medicine.
Cardiac electrophysiology : Study of the electrical properties and conduction diseases of the heart.
Echocardiography : The use of ultrasound to study the mechanical function/physics of the h...